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Emergent Phenol Injection of Bilateral Stellate Ganglion for Management of Refractory Malignant Ventricular Arrhythmias.

Authors :
Luke WR
Daoud EG
Latif OS
Source :
The American journal of case reports [Am J Case Rep] 2020 Mar 19; Vol. 21, pp. e921465. Date of Electronic Publication: 2020 Mar 19.
Publication Year :
2020

Abstract

BACKGROUND Management of incessant electrical storm is poorly defined. These 2 case studies demonstrate a simplified percutaneous approach to achieve stellate ganglion ablation (SGA) and to promptly control malignant ventricular arrhythmias. CASE REPORT This report describes 2 patients with deteriorating hemodynamics, progressive ventricular arrhythmias, and worsening heart failure, managed with emergent percutaneous fluoroscopically-guided bilateral SGA to achieve bilateral cardiac sympathetic denervation. While supine and intubated, the left and then right stellate ganglion were identified guided by anatomic landmarks. Using a 22-guage, 3.5-inch spinal needle, contrast dye was injected with appropriate outline of the stellate ganglion at the uncinate process of the C6 vertebra. Bupivacaine 0.5% was injected, followed by phenol 6%. Successful SGA was confirmed by intentional Horner's syndrome with bilateral eye lag. The procedures were completed in about 30 min without complications and there was a dramatic reduction in ventricular arrhythmias. CONCLUSIONS Emergent percutaneous bilateral SGA can be accomplished with a brief procedure resulting in management of electrical storm.

Details

Language :
English
ISSN :
1941-5923
Volume :
21
Database :
MEDLINE
Journal :
The American journal of case reports
Publication Type :
Report
Accession number :
32188839
Full Text :
https://doi.org/10.12659/AJCR.921465